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E/m Visit 51. 59 modifier Questions

  1. #1
    Question E/m Visit 51. 59 modifier Questions
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    I have Questions about the 51 and the 59 modifier use say I am billing 5 different procedures I am having issues getting things paid I have conflicting info just need someone to tell how to correctly use them and how too do this. So theoretically say I use 99212 ,93000(EKG),94760(oximetry),69210(ear wash),17110 (wart-dest.).
    Also on the injections for multiple ones and excise of lesion I know there is a specific way to code if you have a lot say like 14

  2. #2
    Wink Multi-talented docs
    If the procedures are performed on the same day as your E/M, enter your E/M code with a -25 modifier and then your most expensive procedure first. Add a -59 modifier to any additional procedures or your insurance co will bundle. If your provider has already evaluated on a previous visit and no other medical issues were dealt with, the E/M service was charged on the previous visit, so enter your procedure charges only.

  3. #3
    So I understand that part of it I had heard that you put a 51 on all procedures that are seperate than the e/m so is that not true and If so do i start right after the visit puting modifiers or do i skip one then go to next . IE: 99212.25, 98941,90747.59 is this the way or do i put a modifier on the 98941 ??????? You can tell I am so confused

  4. #4
    Columbia, MO
    You use the 51 modifier on a second and subsequent procedure when all are performed in the same session. You use the 59 modifer on a "bundled" procedure or duplicate code to indicate separate body area, separate incision, or separate organ.
    Your original example included a pulse ox and impacted cerumen removal. The pulse ox is considered bundled to the E&M by several payers and no modifier is going to unbundle it for separate payment. The 69210 is not a code for an ear wash, it must be impacted removal using a scoop or curette and must be physician performed. Again many payers will trend this and bundle it to the E&M to force you to appeal to show you have a physician procedure using a scoop or currette and no an ear wash. You should need no modifier on the 69210 if your only other procedure was an EKG as there is no way to bundle these two procedures. Therefore you can conclude that the payer bundled the 69210 with the E&M and you need to determine if you have the documentation appeal with, if you do not then you should not have billed it in the beginning.

    Debra A. Mitchell, MSPH, CPC-H

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